The relationship between gastroesophageal reflux disease and its complications with Barrett's esophagus.

BACKGROUND Barrett's esophagus is a condition in which the stratified squamous epithelium of the esophagus is replaced by a columnar epithelium with malignant potential. Chronic gastroesophageal reflux disease (GERD) is accepted as the primary risk factor for the development of Barrett's esophagus, but only a small fraction of individuals with GERD develop Barrett's esophagus. We sought to identify factors that increase the risk of Barrett's esophagus in those with GERD. OBJECTIVE The objective of this matched case-control study was to investigate possible clinical risk factors for Barrett's esophagus. METHODS The study was based on 79 case patients with Barrett's esophagus and 180 control patients. Each case patient was matched to one control patient whose indication for endoscopy was GERD and one control patient who underwent endoscopy for other indications. The case and control patients were matched for age, gender, and race. All patients underwent endoscopy at Duke University Medical Center, Durham, NC, between July 1992 and August 1994. RESULTS On average, patients with Barrett's esophagus developed reflux symptoms at an earlier age than age- and gender-matched control patients and also had a longer duration of symptoms. Complications of reflux, including esophagitis, stricture, and ulceration, were reported significantly more frequently in the group of case patients than either group of control patients. CONCLUSIONS The results of this pilot study indicate that age of onset, duration of symptoms, and complications of GERD may be markers of increased risk of Barrett's esophagus.